Category Archives: Pain script

“IT’S A PAIN!” Use Evidence to Address Pain Management Myths

A new threat has emerged in evidence-based management of pain control.  Fear.

Evidence-based practice for pain control has 3 elements:  BEST available evidence + Clinical judgment + Patient/care partner values and preferences.

In the concern over opioid abuse by some patients & professionals, some federal agencies and nonprofits are suggesting that The Joint Commission (TJC) is inadvertently at fault (  HCAHPS questions are also under suspicion.

Pain fistWhile I am not an apologist either for TJC or HCAHPS, my fear is that the government/involved nonprofit fears ignore the data: pain relief is still inadequate for some patients, professionals often under-medicate or don’t believe patients, and some patients have pain crises.  Limiting opioids only to certain diagnoses undercuts evidence-based care.

As a professional RN, you need to check out the best available evidence yourself, use your judgment, and Question1practice pain assessment & management safely. We knowIdea2 that asking patients about suicidal intent does not cause them to commit suicide.  Does asking patients about pain cause them to have it or to treat pain they don’t have?  Hmmm…..

Here are the current TJC standards:  1) The hospital educates all licensed independent practitioners on assessing and managing pain. 2) The hospital respects the patient’s right to pain management. 3) The hospital assesses and manages the patient’s pain.”

Check out this link for truth about the following 5 myths identified by TJC about their standards:

  • Myth#1: The Joint Commission endorses pain as a vital sign…. Vital sign
  • Myth #2: The Joint Commission requires pain assessment for all patients….
  • Myth #3: The Joint Commission requires that pain be treated until the pain score reaches zero….
  • #4: The Joint Commission standards push doctors to prescribe opioids.
  • OxycodoneMyth #5: The Joint Commission pain standards caused a sharp rise in opioid prescriptions. This claim is completely contradicted by data from the National Institute on Drug Abuse.”…  [Source=TJC link above]

Of course, RNs & the health team can always do things better, and the above concerns Hypothesissuggest that we might need new studies. I hope only that we won’t jump on the fear bandwagon.   Keep practice EVIDENCE BASED, listen to patient/carepartner preferences & values, & use your judgment.  

CRITICAL THINKING:  How do you assess patient pain?  How could you improve?  How do you apply TJC standards in your setting?

FOR MORE INFORMATION: Do you know what the TJC pain standards are?  Check out the 5 myth link above.



Stand & Deliver: Evidence for Empathy in Action

Patient Pain Satisfaction.  It’s a key outcome of RN empathy in action.CARE

Imagine that you are hospitalized and hurting.   During hourly rounds the RN reassures you with these words:We are going to do everything that we can to help keep your pain under control. Your pain management is our number 1 priority. Given your [condition, history, diagnosis, status], we may not be able to keep your pain level at zero. However, we will work very hard with you to keep you as comfortable as possible.” (Alaloul et al, 2015, p. 323).

Study? In 2015 a set of researchers tested effectiveness of the above pain script using 2 similar medical-surgical units in an academic medical center—1 unit was an experimental unit & 1 was a control unit.  RNs rounded hourly on both units.  handsOn the experimental unit RNs stated the script to patients exactly as written and on room whiteboards posted the script, last pain med & pain scores.  Posters of the script were also posted on the unit.   In contrast, on the control unit RN communication and use of whiteboard were dependent on individual preferences.  Researchers measured effectiveness of the script by collecting HCAHPS scores 2 times before RNs began using the script (a baseline pretest) and then 5 times during and after RNs began using it (a posttest) on both units.

Results? On the experimental units significantly more patients reported that the team was doing everything they could to control pain and that the pain was well-controlled (p≤.05). And while experimental unit scores were trending up, control unit scores trended down. Other findings were that the RNs were satisfied with the script, and that RNs having a BSN or MSN had no effect.

Conclusions/Implications?When nurses used clear and consistent communication with patients in pain, a positive effect was seen in patient satisfaction with pain management over time. This intervention was simple and effective. It could be replicated in a variety of health care organizations.” (p.321) [underline added]

Commentary: While an experiment would have created greater confidence that the script caused the improvements in patient satisfaction, an experiment would have been difficult or impossible.  Researchers could not randomly assign patients to experimental & control units.  Still, quasi-experimental research is relatively strong evidence, but it leaves the door open that something besides the script caused the improvements in HCAHPS scores.

questionCritical thinking? What would prevent you from adopting or adapting this script in your own personal practice tomorrow?  What are the barriers and facilitators to getting other RNs on your unit to adopt this script, including using whiteboards?  Are there any risks to using the script?  What are the risks to NOT using the script?

Want more info? See original reference – Alaloul, F., Williams, K., Myers, J., Jones, K.D., & Logsdon, M.C. (2015).Impact of a script-based communication intervention on patient satisfaction with pain management. Pain Management Nursing, 16(3), 321-327.